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Medforth N, Boyle C. Challenges, Complexity, and Developments in Transition Services for Young People with Disabilities, Mental Health, and Long-Term Conditions: An Integrative Review. Compr Child Adolesc Nurs 2023; 46:180-200. [PMID: 37639678 DOI: 10.1080/24694193.2023.2245473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Transition to adulthood for young people is complex and multi-faceted, with additional hurdles for young people who have disabilities, long-term, or life-limiting conditions or mental health problems. The challenges in providing effective transition support are not new; researchers, policymakers, commissioners, and service providers have been grappling with the problem for several decades, with varying degrees of success. The aims of this integrative review were firstly to build on previous research to synthesize and evaluate recently published evidence. Secondly to provide an overview of the effectiveness of interventions (in one or a combination of health, social care, and education transitions) designed to support transition to adulthood in these groups of young people. A search of a range of databases retrieved published literature from January 2015 to January 2021 demonstrating global interest in the topic. Fifty-one articles were included following an appraisal of quality and eligibility. Qualitative, quantitative, mixed methods studies, and evidence synthesis were included. Some studies were clinically orientated whilst others examined the impact of the transition process, or utilized participatory approaches which give young service-users and families a voice. Transition between children's and adult health or care services as well as other life-course trajectories, such as life-skills development, education transitions, social inclusion and employability were evaluated. Thematic analysis and synthesis of articles retrieved in this review highlighted themes identified in previous reviews: timing of, and preparation for transition; perceptions and experience of transition; barriers and facilitators; transition outcomes. Additional themes included special considerations; dealing with complexity; advocacy, participation, autonomy, aspirations, and young people's rights; future work, research, and evaluation. Novel perspectives and diverse data sources contributed to holistic understanding of an ongoing priority for international policy, service development, and research: the complexity of providing effective transition support and achieving positive outcomes for young people with long-term and life-limiting health conditions, disabilities, and mental health difficulties.
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Nguyen NAT, Auquier P, Beltran Anzola A, Harroche A, Castet S, Huguenin Y, Meunier S, Repesse Y, D'Oiron R, Rauch A, Desprez D, Spiegel A, Chamouni P, Schneider P, Baumstarck K, Boucekine M, Tabele C, Viprey M, Leroy T, Roques MA, Sannie T, Giraud N, Chambost H, Resseguier N. Determinants of adherence and consequences of the transition from adolescence to adulthood among young people with severe haemophilia (TRANSHEMO): A multicentric French national observational cross-sectional study based on the FranceCoag registry. Haemophilia 2023; 29:1202-1218. [PMID: 37572328 DOI: 10.1111/hae.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION It is necessary to gain insights into adherence to healthcare in people with severe haemophilia (PwSH), especially during the transition from paediatric to adult care, which is an important phase in lives of young people with childhood chronic disease. This adherence can be considered as a marker of successful transition. OBJECTIVES The main objective of the quantitative phase of the TRANSHEMO project was to compare the adherence to healthcare between adolescents and young adults (YAs) with severe haemophilia. The secondary objective was to identify the determinants (facilitators and barriers) of this adherence and associations between these determinants. METHODS A multicentre, observational, cross-sectional study was conducted in 2017-2019 on PwSH aged between 14 and 17 years (adolescents) or between 20 and 29 years (YAs), included in the FranceCoag registry and having completed the questionnaires. The adherence to healthcare (treatment regimens and clinical follow-up) was compared between adolescents and YAs using the chi-squared test. The determinants of this adherence were analysed by structural equation modelling. RESULTS There were 277 participants, 107 adolescents, and 170 YAs. The rate of adolescents adhering to healthcare was 82.2%, while the rate of YAs was 61.2% (p < .001). The barriers to the adherence to healthcare were being YA, having repeated at least one school grade and presenting mental health concerns. CONCLUSION Adolescents had better adherence to healthcare than YAs. According to the determinants enlightened in this project, targeted supportive strategies and adapted therapeutic education programs can be developed for young PwSH to facilitate their adherence to healthcare.
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Affiliation(s)
- Ngoc Anh Thu Nguyen
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Pascal Auquier
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- FranceCoag Network, Marseille, France
| | - Any Beltran Anzola
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Annie Harroche
- AP-HP, Haemophilia Treatment Centre, Hospital Necker, Paris, France
| | - Sabine Castet
- University Hospital of Bordeaux, Haemophilia Treatment Centre, Bordeaux, France
| | - Yoann Huguenin
- University Hospital of Bordeaux, Haemophilia Treatment Centre, Bordeaux, France
| | - Sandrine Meunier
- Hospices Civils de Lyon - Haemophilia Treatment Centre, Groupement Hospitalier Est, Bron, France
| | - Yohann Repesse
- University Hospital of Caen, Haemophilia Treatment Centre, Caen, France
| | - Roseline D'Oiron
- AP-HP, Haemophilia Treatment Centre, Hospital Bicêtre, Paris, France
| | - Antoine Rauch
- University Regional Hospital of Lille, Haemophilia Treatment Centre, Lille, France
| | - Dominique Desprez
- University Regional Hospital of Strasbourg, Haemophilia Treatment Centre, Strasbourg, France
| | - Alexandra Spiegel
- University Regional Hospital of Strasbourg, Pediatric Onco-Haematology Service, Strasbourg, France
| | - Pierre Chamouni
- University Hospital of Rouen, Haemophilia Treatment Centre, Rouen, France
| | - Pascale Schneider
- University Hospital of Rouen, Haemophilia Treatment Centre, Rouen, France
| | - Karine Baumstarck
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- FranceCoag Network, Marseille, France
| | - Mohamed Boucekine
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- FranceCoag Network, Marseille, France
| | - Clémence Tabele
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- FranceCoag Network, Marseille, France
| | - Marie Viprey
- FranceCoag Network, Marseille, France
- Hospices Civils de Lyon, Health Data Department, Lyon, France
- Inserm, U1290 Unit, Research on Healthcare Performance RESHAPE, Claude Bernard Lyon 1 University, Lyon, France
| | - Tanguy Leroy
- Inserm, U1296 Unit, Radiation: Defense, Health and Environment, Lumière Lyon 2 University, Lyon, France
| | - Marie-Anaïs Roques
- Laboratory of Clinical Psychology, Psychopathology and Psychoanalysis, UR 3278, Aix-Marseille University, Aix-en-Provence, France
- AP-HM, Haemophilia Treatment Centre, Children Hospital La Timone, Marseille, France
| | - Thomas Sannie
- French Patients' Association for People with Haemophilia (AFH), Paris, France
| | - Nicolas Giraud
- French Patients' Association for People with Haemophilia (AFH), Paris, France
| | - Hervé Chambost
- FranceCoag Network, Marseille, France
- AP-HM, Haemophilia Treatment Centre, Children Hospital La Timone, Marseille, France
| | - Noémie Resseguier
- CEReSS/UR 3279 - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
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Recombinant Factor VIII Fc Fusion Protein (rFVIIIFc) in Real Life: One-Year Clinical and Economic Outcomes. Drugs Real World Outcomes 2021; 8:527-535. [PMID: 34170499 PMCID: PMC8605945 DOI: 10.1007/s40801-021-00259-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Recombinant factor VIII Fc fusion protein (rFVIIIFc) is the first extended half-life (EHL) recombinant clotting factor with marketing authorization; it has been available in France since October 2016. However, data and literature about rFVIIIFc in clinical practice are scarce. Objective We propose a 1-year clinical and economic outcome evaluation in patients with hemophilia A taking into consideration treatment adherence. Patients and methods We reviewed the diaries of all patients treated with rFVIIIFc at Marseille Hemophilia Center for 1 year. All the data were related to the patients’ infusion (i.e., annual number of infusions, weekly dose/kg, and annual consumption) and bleeding reports. The clotting factor costs were considered, whereas additional costs (e.g., infusion devices and nurse intervention) were neglected. Results A total of 34 patients were evaluated. Their median age was 18 years (IQR = 18). Treatment adherence was observed in 62% for FVIII and 66% for rFVIIIFc. The analysis revealed a negligible decrease in the annual clotting factor consumption following the switch (− 2%, p = 0.7339). These data were combined with a significant reduction in the annual number of infusion (− 22.5%, median = 138.5, IQR = 65.8 for FVIII; median = 105, IQR = 24 for rFVIIIFc, p < 0.0001) and bleeding (− 50%, median = 5, IQR = 7.5 for FVIII; median = 1, IQR = 4 for rFVIIIFc, p < 0.0001). With regard to the cost, a decreasing trend was observed (− 8%, p = 0.1300). Conclusion The analysis in a real-life setting revealed that the input of switches toward rFVIIIFc in different treatment (age of patients and regimen) patterns seems to corroborate previous studies. The results suggest that switches have a beneficial effect in terms of efficacy, clotting factor consumption, and cost.
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Polack B, Trossaërt M, Cousin M, Baffert S, Pruvot A, Godard C. Cost-effectiveness of emicizumab vs bypassing agents in the prevention of bleeding episodes in haemophilia A patients with anti-FVIII inhibitors in France. Haemophilia 2020; 27:e1-e11. [PMID: 33210412 DOI: 10.1111/hae.14129] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/16/2020] [Accepted: 07/27/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The development of an anti-FVIII inhibitor is the most serious complication of haemophilia A occurring in up to 30% of severe haemophilic patients. The current management of haemophilia A with inhibitor uses bypassing agents (BPA) and represents a significant therapeutic burden together with a limited adherence to prophylactic treatment. Emicizumab is the first monoclonal antibody developed in haemophilia A approved for the prevention of bleeding episodes in patients with anti-FVIII inhibitor. AIM The purpose of this study is to evaluate the incremental cost-effectiveness ratio (ICER) of emicizumab versus BPAs. METHODS A Markov model was developed over a five-year time horizon to estimate the comparative costs and benefits of the different therapeutic approaches in this rare disease. Model inputs were clinical, including annual bleeding rate and quality of life, and economical including mainly costs of prophylaxis, bleeds and adverse events. RESULTS Emicizumab treatment is dominant, ie lest costly and more effective, in the base-case analysis saving 234 191 € for a gain of 0.88 QALY. This is confirmed by both the deterministic and probabilistic sensitivity analyses. The main limit of the study remains the absence of long-term clinical data allowing to relate treatment consumption to clinical benefit, especially in the progression of haemophilic arthropathy. CONCLUSION Our results show that emicizumab is a cost-effective treatment allowing to consider an easy to implement prophylactic treatment for haemophilia A patients with anti-FVIII inhibitors.
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Affiliation(s)
- Benoît Polack
- Département d'Hématologie, Centre Hospitalier Universitaire Grenoble Alpes, Laboratoire TIMC-IMAG, Institut de Biologie et de Pathologie, Université Grenoble Alpes, CNRS UMR 5525, Grenoble, France
| | - Marc Trossaërt
- Haemophilia Treatment Center, University Hospital, Nantes, France
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von Mackensen S, Douma Y, Halimeh S. Evaluation of the U.S. Adherence Questionnaires VERITAS-PRO and VERITAS-PRN for Use in Patients with Hemophilia in the German Healthcare System. Hamostaseologie 2020; 40:621-630. [PMID: 33086407 DOI: 10.1055/a-1249-4645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AIM Since the U.S. adherence instruments VERITAS-PRO and VERITAS-PRN were developed in another healthcare system, we assumed that they are not appropriate for the German solidarity healthcare system. This study aims to evaluate the relevance of these instruments for the German healthcare system both by people with hemophilia (PWH) and by healthcare professionals (HCP). METHODS A total of 50 PWH (23 adult hemophilia patients and 27 parents of children with hemophilia) and 25 HCP rated the relevance of the single items of the VERITAS-PRO and VERITAS-PRN on a 5-point Likert scale. In addition, both groups were asked to make suggestions for additional adherence questions. To investigate the relevance of these instruments, the accordance between the raters' evaluations was determined calculating the content validity index (CVI) and the content validity ratio (CVR) based on the critical values of the CVR (CVRcritical) to exclude chance and subjectivity. RESULTS CVI (CVR) calculations revealed three (5) "very important" items for PWH and six (11) items for HCP. Only two (3) "very important" items were evaluated by both groups. Four domains were considered not important by both groups. Six PWH made 14 suggestions and 14 HCP made 24 suggestions for additional adherence questions. CONCLUSION VERITAS-PRO and VERITAS-PRN have only very limited benefits for the German healthcare system. Since nonadherence has a great impact on the morbidity of PWH and on the costs for the healthcare system, there is a need for adherence instruments that are adapted to the specific needs of PWH in the German healthcare system.
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Affiliation(s)
- Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Yves Douma
- GZRR - Gerinnungszentrum Rhein-Ruhr, Duisburg, Germany
| | - Susan Halimeh
- GZRR - Gerinnungszentrum Rhein-Ruhr, Duisburg, Germany
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Strike K, Chan A, Iorio A, Maly MR, Stratford PW, Solomon P. Predictors of treatment adherence in patients with chronic disease using the Multidimensional Adherence Model: unique considerations for patients with haemophilia. ACTA ACUST UNITED AC 2020. [DOI: 10.17225/jhp00152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Adherence to treatment recommendations in patients with chronic disease is complex and is influenced by numerous factors. Haemophilia is a chronic disease with reported levels of adherence ranging from 17–82%.
Aim
Based on the theoretical foundation of the World Health Organization Multidimensional Adherence Model, the objective of this study was to identify the best combination of the variables infusion frequency, annualised bleed rate, age, distance to haemophilia treatment centre (HTC) and Haemophilia Joint Health Score (HJHS), to predict adherence to treatment recommendations in patients with haemophilia A and B on home infusion prophylaxis in Canada.
Methods
A one-year retrospective cohort study investigated adherence to treatment recommendations using two measures: 1) subjective report via home infusion diaries, and 2) objective report of inventory ordered from Canadian Blood Services. Stepwise regression was performed for both measures.
Results
Eighty-seven patients with haemophilia A and B, median age 21 years, were included. Adherence for both measures was 81% and 93% respectively. The sample consisted largely of patients performing an infusion frequency of every other day (34%). Median scores on the HJHS was 10.5; annualised bleed rate was two. Distance to the HTC was 51km. Analysis of the objective measure weakly supported greater infusion frequency as a treatment-related factor for the prediction of lower adherence, however the strength of this relationship was not clinically relevant (R2=0.048). For the subjective measure, none of the explanatory variables were significant.
Conclusion
Adherence is a multifaceted construct. Despite the use of theory, most of the variance in adherence to treatment recommendations in this sample of patients with haemophilia remains unknown. Further research on other potential predictors of adherence, and possible variables and relationships within factors of the MAM is required.
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Affiliation(s)
- Karen Strike
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
| | - Anthony Chan
- Department of Pediatrics , McMaster University , Hamilton , Ontario , Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact (HEI) , McMaster University , Hamilton , Ontario , Canada
| | - Monica R. Maly
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario ; Department of Kenesiology, Faculty of Applied Health Sciences , University of Waterloo , Waterloo , Canada
| | - Paul W. Stratford
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
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